Provider Demographics
NPI:1083731137
Name:NEW BRITAIN OBSTETRICAL & GYNECOLOGICAL GROUP PC
Entity Type:Organization
Organization Name:NEW BRITAIN OBSTETRICAL & GYNECOLOGICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:LILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-224-2447
Mailing Address - Street 1:40 HART ST
Mailing Address - Street 2:BLDG A, 2ND FLR
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1743
Mailing Address - Country:US
Mailing Address - Phone:860-224-2447
Mailing Address - Fax:860-826-5845
Practice Address - Street 1:40 HART ST
Practice Address - Street 2:BLDG A, 2ND FLR
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1743
Practice Address - Country:US
Practice Address - Phone:860-224-2447
Practice Address - Fax:860-826-5845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004393922Medicaid
CTC00105Medicare ID - Type UnspecifiedGROUP NUMBER